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May 18, 1994, Vol 271, No. 19 >
ARTICLE | May 18, 1994

Financing Long-term Care: Title and subTitle BreakA Proposal by the American College of Physicians and the American Geriatrics Society FREE

Janet Weiner, MPH
[+] Author Affiliations

This proposal was developed by the American College of Physicians Subcommittee on Aging and a joint committee of the American Geriatrics Society.

This article was approved by the American College of Physicians Board of Regents on July 17, 1993, and by the American Geriatrics Society Executive Board on August 30, 1993.

Reprint requests to American College of Physicians, Sixth Street and Race, Philadelphia, PA 19106 (Ms Weiner).


JAMA. 1994;271(19):1525-1529. doi:10.1001/jama.1994.03510430079039
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References

THE United States is poised on an ethical precipice as it deliberates health system reform. As the debate continues about revolutionary changes in the organization and financing of health care, the following dilemma arises: can the long-term care needs of the chronically ill and disabled be included, without dooming the reform itself to political and financial failure?

In 1991, the United States spent $59.9 billion on nursing home care (about 8% of total health care expenditures)1 and $9.8 billion (1% of national health spending) on formal home health services (services provided by non-facility-based agencies). The reluctance to include long-term care in health system reform stems not from the magnitude of present expenditures, but rather from the anticipation of rapidly rising expenditures in the foreseeable future. Home health care is the fastest growing component of personal health care spending, having risen sevenfold in the last decade and 29% from 1990

REFERENCES

1 +
Letsch SW, Lazenby HC, Levit KR, Cowan CA.  National health expenditures, 1991. Health Care Financ Rev . 1992;;14:6-30.
2 +
US Senate Special Committee on Aging. Aging America: Trends and Projections . Washington, DC: US Government Printing Office; 1991;.
3 +
Short PF, Kemper P, Cornelius LJ, Walden DC.  Public and private responsibility for financing nursing home care; the effect of Medicaid asset spend-down. Milbank Q . 1992;;70:277-298.
4 +
Adams EK, Meiners MR, Burwell BA.  Asset spend-down in nursing homes: methods and insights. Med Care . 1993;;31:1-23.
5 +
Harrington C, Cassel C, Estes C, Woolhandler S, Himmelstein DU, the Working Group on Long-term Care Program Design.  Physicians for a National Health Program: a national long-term care program for the United States: a caring vision. JAMA .1991;;266:3023-3029.
6 +
American Geriatrics Society. Position Paper on Health Reform . Washington, DC: American Geriatrics Society; 1993;.
7 +
American College of Physicians.  Universal insurance for American health care: a proposal of the American College of Physicians. Ann Intern Med . 1992;;117:511-519.
8 +
Merrill J.  A test of our society: how and for whom we finance long-term care. Inquiry . 1992;;29: 176-187.
9 +
Pawlson LG.  Financing long-term care: the growing dilemma. J Am Geriatr Soc . 1989;;37:631-638.
10 +
Congressional Budget Office. Policy Choices for Long-term Care . Washington, DC: Congressional Budget Office; 1991;.
11 +
Lair T, Lefkowitz D. Mental Health and Functional Status of Residents of Nursing and Personal Care Homes . Rockville, Md: Public Health Service; 1990;. US Dept of Health and Human Services publication PHS 90-3470.
12 +
Kemper P, Spillman BC, Murtagh CM.  A lifetime perspective on proposals for financing nursing home care. Inquiry . 1991;;28:3333-3344.
13 +
Garfinkel SA, Riley GF, Iannacchione VG.  Highcost users of medical care. Health Care Financ Rev . 1988;;9:41-43.
14 +
Leutz W, Abrahams R, Capitman J.  The administration of eligibility for community long-term care. Gerontologist . 1993;;33:92-104.
15 +
Zawadski RT, Eng C.  Case management in capitated long-term care. Health Care Financ Rev . 1988;(annual suppl):75-81.
16 +
Moon M.  Taking the plunge: the arguments for a comprehensive long-term care system. J Am Geriatr Soc . 1989;;37:1165-1170.
17 +
Pawlson LG, Lavizzo-Mourey RJ.  Financing long-term care: an insurance based approach. J Am Geriatr Soc . 1990;;38:696-703.
18 +
Ball RM.  Public-private solution to protection against the cost of long-term care. J Am Geriatr Soc . 1990;;38:156-163.
19 +
HR 651: Mediplan Long-term Care Act of 1991.
20 +
Mahoney KJ, Wetle T.  Public-private partnerships: the Connecticut model for financing long-term care. J Am Geriatr Soc . 1992;;40:1026-1030.
21 +
Arling G, Hagan S, Dring H.  The feasibility of a public-private long-term care financing plan. Med Care . 1992;;30:699-717.
22 +
Families USA Foundation. Nursing Home Insurance: Who Can Afford It? Washington, DC: Families USA Foundation; 1993;.
23 +
Rivlin A, Wiener J. Caring for the Disabled Elderly: Who Will Pay? Washington, DC: Brookings Institution; 1988;.
24 +
Friedland R. Facing the Costs of Long-term Care . Washington, DC: Employee Benefits Research Institute; 1990;.
25 +
Cohen MA, Kumar N, Wallack SS.  New perspectives of the affordability of long-term care insurance and potential market size. Gerontologist . 1993;;33:105-113.
26 +
American College of Physicians.  Financing long-term care. Ann Intern Med . 1988;;108:279-288.
27 +
Spillman BC, Kemper P.  Longterm care arrangements for elderly people with disabilities: public and private roles. Home Health Serv Q . 1992;;13:5-34.
28 +
US Bipartisan Commission on Comprehensive Health Care. A Call For Action . Washington, DC: US Bipartisan Commission on Comprehensive Health Care; 1990;. US Government Printing Office publication 101-114.
29 +
Short P, Leon J. Use of Home and Community Services by Persons Ages 65 and Older With Functional Difficulties . Rockville, Md: Public Health Service; 1990;. US Dept of Health and Human Services publication PHS 90-3466.
30 +
Kane RL.  Rethinking long-term care. J Am Geriatr Soc . 1990;;38:704-709.
31 +
Coburn AF, Fortinsky R, McGuire C, McDonald TP.  Effect of prospective reimbursement on nursing home care costs. Health Serv Res . 1993;;28:45-68.
32 +
Buchanan RJ, Madel RP, Persons D.  Medicaid payment policies for nursing home care: a national survey. Health Care Financ Rev . 1991;;13:55-71.
33 +
Clauser SB, Fries BE.  Nursing home resident assessment and case-mix classification: cross-national perspectives. Health Care Financ Rev . 1992;; 13:135-155.
34 +
Advisory Council on Social Security. Commitment to Change: Foundation for Reform . Washington, DC: Advisory Council on Social Security; December 1991;.
35 +
American Association of Retired Persons. Options for the Public Financing of Long-term Care . Washington DC: Public Policy Institute; 1989;. American Association of Retired Persons publication 8908.
36 +
Coughlin TA, McBride TD, Perozek M, Liu K.  Home care for the disabled elderly: predictors and expected costs. Health Serv Res . 1992;;27:453-479.
37 +
Kemper P.  The evaluation of the National Long Term Care Demonstration, 10: overview of the findings. Health Serv Res . 1988;;23:161-174.
38 +
Edelman P, Hughes S.  The impact of community care on provision of informal care to homebound elderly persons. J Gerontol . 1990;;45:S74-S84.
39 +
Gold SD.  One approach to tracking state and local health spending. Health Aff (Millwood) . 1992;; 11:135-144.
40 +
 Medicaid saps higher education funds. Med Health . 1993;;47:1.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Letsch SW, Lazenby HC, Levit KR, Cowan CA.  National health expenditures, 1991. Health Care Financ Rev . 1992;;14:6-30.
2 +
US Senate Special Committee on Aging. Aging America: Trends and Projections . Washington, DC: US Government Printing Office; 1991;.
3 +
Short PF, Kemper P, Cornelius LJ, Walden DC.  Public and private responsibility for financing nursing home care; the effect of Medicaid asset spend-down. Milbank Q . 1992;;70:277-298.
4 +
Adams EK, Meiners MR, Burwell BA.  Asset spend-down in nursing homes: methods and insights. Med Care . 1993;;31:1-23.
5 +
Harrington C, Cassel C, Estes C, Woolhandler S, Himmelstein DU, the Working Group on Long-term Care Program Design.  Physicians for a National Health Program: a national long-term care program for the United States: a caring vision. JAMA .1991;;266:3023-3029.
6 +
American Geriatrics Society. Position Paper on Health Reform . Washington, DC: American Geriatrics Society; 1993;.
7 +
American College of Physicians.  Universal insurance for American health care: a proposal of the American College of Physicians. Ann Intern Med . 1992;;117:511-519.
8 +
Merrill J.  A test of our society: how and for whom we finance long-term care. Inquiry . 1992;;29: 176-187.
9 +
Pawlson LG.  Financing long-term care: the growing dilemma. J Am Geriatr Soc . 1989;;37:631-638.
10 +
Congressional Budget Office. Policy Choices for Long-term Care . Washington, DC: Congressional Budget Office; 1991;.
11 +
Lair T, Lefkowitz D. Mental Health and Functional Status of Residents of Nursing and Personal Care Homes . Rockville, Md: Public Health Service; 1990;. US Dept of Health and Human Services publication PHS 90-3470.
12 +
Kemper P, Spillman BC, Murtagh CM.  A lifetime perspective on proposals for financing nursing home care. Inquiry . 1991;;28:3333-3344.
13 +
Garfinkel SA, Riley GF, Iannacchione VG.  Highcost users of medical care. Health Care Financ Rev . 1988;;9:41-43.
14 +
Leutz W, Abrahams R, Capitman J.  The administration of eligibility for community long-term care. Gerontologist . 1993;;33:92-104.
15 +
Zawadski RT, Eng C.  Case management in capitated long-term care. Health Care Financ Rev . 1988;(annual suppl):75-81.
16 +
Moon M.  Taking the plunge: the arguments for a comprehensive long-term care system. J Am Geriatr Soc . 1989;;37:1165-1170.
17 +
Pawlson LG, Lavizzo-Mourey RJ.  Financing long-term care: an insurance based approach. J Am Geriatr Soc . 1990;;38:696-703.
18 +
Ball RM.  Public-private solution to protection against the cost of long-term care. J Am Geriatr Soc . 1990;;38:156-163.
19 +
HR 651: Mediplan Long-term Care Act of 1991.
20 +
Mahoney KJ, Wetle T.  Public-private partnerships: the Connecticut model for financing long-term care. J Am Geriatr Soc . 1992;;40:1026-1030.
21 +
Arling G, Hagan S, Dring H.  The feasibility of a public-private long-term care financing plan. Med Care . 1992;;30:699-717.
22 +
Families USA Foundation. Nursing Home Insurance: Who Can Afford It? Washington, DC: Families USA Foundation; 1993;.
23 +
Rivlin A, Wiener J. Caring for the Disabled Elderly: Who Will Pay? Washington, DC: Brookings Institution; 1988;.
24 +
Friedland R. Facing the Costs of Long-term Care . Washington, DC: Employee Benefits Research Institute; 1990;.
25 +
Cohen MA, Kumar N, Wallack SS.  New perspectives of the affordability of long-term care insurance and potential market size. Gerontologist . 1993;;33:105-113.
26 +
American College of Physicians.  Financing long-term care. Ann Intern Med . 1988;;108:279-288.
27 +
Spillman BC, Kemper P.  Longterm care arrangements for elderly people with disabilities: public and private roles. Home Health Serv Q . 1992;;13:5-34.
28 +
US Bipartisan Commission on Comprehensive Health Care. A Call For Action . Washington, DC: US Bipartisan Commission on Comprehensive Health Care; 1990;. US Government Printing Office publication 101-114.
29 +
Short P, Leon J. Use of Home and Community Services by Persons Ages 65 and Older With Functional Difficulties . Rockville, Md: Public Health Service; 1990;. US Dept of Health and Human Services publication PHS 90-3466.
30 +
Kane RL.  Rethinking long-term care. J Am Geriatr Soc . 1990;;38:704-709.
31 +
Coburn AF, Fortinsky R, McGuire C, McDonald TP.  Effect of prospective reimbursement on nursing home care costs. Health Serv Res . 1993;;28:45-68.
32 +
Buchanan RJ, Madel RP, Persons D.  Medicaid payment policies for nursing home care: a national survey. Health Care Financ Rev . 1991;;13:55-71.
33 +
Clauser SB, Fries BE.  Nursing home resident assessment and case-mix classification: cross-national perspectives. Health Care Financ Rev . 1992;; 13:135-155.
34 +
Advisory Council on Social Security. Commitment to Change: Foundation for Reform . Washington, DC: Advisory Council on Social Security; December 1991;.
35 +
American Association of Retired Persons. Options for the Public Financing of Long-term Care . Washington DC: Public Policy Institute; 1989;. American Association of Retired Persons publication 8908.
36 +
Coughlin TA, McBride TD, Perozek M, Liu K.  Home care for the disabled elderly: predictors and expected costs. Health Serv Res . 1992;;27:453-479.
37 +
Kemper P.  The evaluation of the National Long Term Care Demonstration, 10: overview of the findings. Health Serv Res . 1988;;23:161-174.
38 +
Edelman P, Hughes S.  The impact of community care on provision of informal care to homebound elderly persons. J Gerontol . 1990;;45:S74-S84.
39 +
Gold SD.  One approach to tracking state and local health spending. Health Aff (Millwood) . 1992;; 11:135-144.
40 +
 Medicaid saps higher education funds. Med Health . 1993;;47:1.

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